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Programmatic and research considerations for hormonal contraception for women at risk of HIV and women living with HIV.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2012 May.  p. (Policy Implications; WHO/RHR/12.09)Between 31 January and 2 February 2012, the World Health Organization (WHO) convened a meeting of experts to discuss recent research on use of hormonal contraception by women at high risk of HIV and those currently living with HIV and its implications. The purpose of the meeting was to review all available published evidence on the relationship between the use of hormonal contraceptives and the risk of HIV acquisition, HIV disease progression, and HIV transmission to uninfected partners, and to determine whether any change in the WHO recommendations on hormonal contraceptive use by women at high risk of, or living with, HIV-infection was needed. During the discussion on the balance of risks and benefits of hormonal contraceptive use among women at high risk of, or living with, HIV infection, multiple programmatic and research issues emerged, including priority knowledge gaps. This brief serves to highlight actions that programmes providing sexual and reproductive health and HIV-prevention services should undertake, in order to complement the Consultation’s recommendations. Directions for future research to address current gaps are noted. (Excerpts)
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, DC, December 10-14, 1990, edited by John T. Queenan, Victoria H. Jennings, Jeffrey M. Spieler, Helena von Hertzen. [Washington, D.C.], Georgetown University, Institute for International Studies in Natural Family Planning, . 9.The World Health Organization has two sections which work in the field of natural family planning: the Division of Family Health through its Maternal and Child Health and Family Planning Program (MCH), and the Special Program of Research, Development, and Research Training in Human Reproduction (HRP) through its Task Force on methods for the Natural Regulation of Fertility. The MCH focus upon education and services complements the HRP's efforts in biomedical research. The long-term objective of task force research is to improve the performance of methods used for NFP. The main research areas are lactation, indices of the fertile period, and NFP, with primary emphasis given to lactation and its contribution to the natural suppression of fertility. Lactation is receiving high priority because breastfeeding makes an important contribution to infant and maternal health, and to birth spacing. Moreover, breastfeeding is the only form of birth spacing available to many women in the developing world.
Creating common ground in Asia: women's perspectives on the selection and introduction of fertility regulation technologies.
Geneva, Switzerland, World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction, 1994. 45 p.Participants from Bangladesh, India, Indonesia, the Philippines, and other countries with which WHO's Special Programme of Research, Development, and Research Training in Human Reproduction collaborates and in which women's groups are active attended the Asian regional meeting on Women's Perspectives on the Research and Introduction of Fertility Regulation Technologies in February 1991. The meeting aimed to establish a dialogue between women's groups and researchers, policymakers, and family planning service providers. Other objectives included defining women's needs and viewpoints on reproductive health and fertility regulating technologies and identifying appropriate follow-up activities which would form a basis for regional networking. WHO's Special Programme of Research, Development, and Research Training in Human Reproduction published a report of the meeting. The meeting consisted of plenary sessions, group work, and keynote presentations. Presentations addressed women's realities, policy considerations, research, and service provision. Topics concerning women's realities were community attitudes towards fertility and its control, women's autonomy, health status, and family planning services. Presentations on policy considerations covered: taking users into account, objectives of family planning programs, participation in decision making, and men's responsibility. Redefining safety and acceptability as well as research on female barrier methods were addressed during presentations on research. The report presents proposals for action for Bangladesh, India, Indonesia, and the Philippines. Meeting participants reached a consensus on recommendations addressing policy, research, services, and WHO. The report concludes with a list of participants and a list of papers presented.
New York, New York, Population Council, 1994. 138 p.The Population Council operates programs in approximately 50 countries in Latin America and the Caribbean, West Asia and North Africa, South and East Asia, and sub-Saharan Africa. Its goals are to improve reproductive health and to achieve a humane, equitable, and sustainable balance between people and resources. Its staff of 360 individuals from 64 countries is funded (over US$49 million for 1994) through governments and UN agencies, nongovernmental organizations, and individuals. To achieve its goals, the Council is active in the areas of contraceptive development and reproductive physiology; population policy; family planning and fertility; reproductive health and child survival; gender, family, and development; expanding contraceptive choice; publications and public information; and strengthening professional resources. This annual report presents a list of the Board of Trustees and officers of the Council and the President's report. Recent activities are detailed for the Center for Biomedical Research, the Research Division, the Programs Division and Office of Communications of the Council. A profile is given of the work of the Distinguished Scholar and Distinguished Scientist. Activities designed to strengthen professional resources are covered, and the work of the Council's support systems is described. The annual report includes lists of Council publications, staff members, consultants, advisory and collaborative bodies, fellows, awards, contracts, and fellowships. The report ends with detailed financial statements for the year ending December 31, 1993 and the addresses of the Council's regional and country offices.
Expanding family planning options through the systematic introduction and appropriate management of contraceptive methods.
In: Challenges in reproductive health research: biennial report 1992-1993, edited by J. Khanna, P.F.A. Van Look, P.D. Griffin. Geneva, Switzerland, World Health Organization [WHO], Special Programme of Research, Development and Research Training in Human Reproduction, 1994. 151-60.The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction over 1992-93 continued researching the introduction of new and underused methods of fertility regulation into family planning programs with the goal of helping governments expand the selection of available contraceptive options. The program first researched introducing the once-a-month injectable contraceptive, Cyclofem, in several developing countries based upon the introduction of Norplant. This study led to a new introduction strategy based on the realization that product-specific approaches do not necessarily help family planning programs assess the ability of the service system to provide new methods with the appropriate quality of care under routine conditions. The new three-stage strategy implemented at the country level is described. It is designed to assist decision making by focusing upon users' needs for fertility regulation methods and the capability of services to provide these methods with appropriate quality of care, addressing the interfaces between use, the service delivery system, and technology. The three stages are as follows: assessment of user needs and service delivery needs and capabilities, service delivery and other introductory research, and use of the research findings for decision-making, policy formulation, and strategic planning. Closing sections consider regional centers and technical assistance; information, education, and communication; and product management and the transfer of technology.
Research Triangle Park, North Carolina, FHI, 1990. 45 p.This report describes the Family Health International's (FHI) efforts in the areas of access to contraceptive methods, reproductive health services, and AIDS prevention during 1988-90. Founded in 1971, FHI has developed into a major multidisciplinary organization whose program divisions include AIDSTECH (engaged in AIDS prevention efforts), Clinical Trials, Field Development and Training, Materials Technology, Program Evaluation, and Reproductive Epidemiology, and Sexually Transmitted Diseases. FHI has supported research into long-acting steroid systems such as NORPLANT, as well as research into sterilization and barrier methods. FHI has also established a programs to facilitate the introduction of new contraceptive methods and to improve the use of contraceptives. The organization has also devoted considerable efforts into AIDS prevention activities in 45 developing countries. Examples of FHI AIDS prevention efforts include the establishment of intervention programs among commercial prostitutes and blood screening programs. Other FHI activities include promoting the practice of breastfeeding, instructing policymakers as to the overall health effects of contraception, conducting pioneering research on maternal and infant mortality and morbidity, developing sustainable family planning, and developing new communication strategies. Finally, responding to the rising demand for family planning services and the increasing scarcity of resources, FHI has embarked on an initiative to examine the economics of family planning.
Reproductive health: a key to a brighter future. Biennial report 1990-1991. Special 20th anniversary issue.
Geneva, Switzerland, World Health Organization [WHO], 1992. xiii, 171 p.WHO established its Special Programme of Research, Development, and Research Training in Human Reproduction in 1972 to promote, coordinate, conduct, and evaluate research in human reproduction in both developed and developing countries. Its aim is to assist developing countries meet the reproductive health needs of their populations. The first section of the biennial report discusses the reproductive health status in the world including fertility regulation, sexual health, infertility, and safe motherhood since 1972. Despite considerable progress in the last 20 years, unmet needs remain substantial. New environmental concerns related to population growth and maternal and child health concerns, women's status, and human development all dictate a sense of urgency. The second section covers specific activities of the Programme in the last 20 years. It includes the results of an external evaluation of the effect the Programme has had. It found the Programme's effect to be most successful due to its collaborating centers and multicenter trials and studies, epidemiologists, clinicians, and laboratory scientists. This section also includes viewpoints from China, Kenya, and Mexico. 2 former directors of the Programme present a historical account of the Programme's accomplishments. The third section discusses progress the Programme had made during 1990-91. It specifically covers development and assessment of fertility regulation technologies, prevention of infertility, improving family planning choices through systematic introduction and proper management of contraceptive methods, epidemiologic research, social measurements of reproductive health, and improving capacity for key national reproductive health research.
POPULI. 1993 Feb; 20(2):12-3.The Delhi Declaration and Vision 2000 is IPPF's strategic plan for directing efforts through the end of the 20th century. This brave and angry plan points out the need for IPPF to interact more closely with women's groups and nongovernmental organizations to address the needs of marginalized people. Women's status is lower than that of men in most societies. During the 1980s, family planning (FP) programs in some developing countries (e.g., Bangladesh, Brazil, India, and Mexico) directly or structurally pressured women to become sterilized or take part in clinical trials of injectable contraceptives and subdermal implants. IPPF calls for more funds from donor governments for research and development because pharmaceutical companies do the research, but lawsuits, adverse publicity, and consumer campaigns have resulted in reduced pharmaceutical company supported research. Adverse publicity has also been waged against international FP and population control groups, mainly because they do not include women in decision-making roles in all aspects of contraception research. The Declaration calls for a wider women's role in making decisions affecting FP, sexual health, and reproductive rights. Developed and developing countries should share power and freedom. Contraception has brought about positive changes in women's lives, e.g., better health for mother and child. About 51% of couples in developing countries use FP methods, but 300 - 500 million married women who want to use contraceptive still do not have access to it. Since religion, tradition, and peer pressure influence family size, public education is needed. The media needs to become more objective when they report on FP successes rather than on 1 problematic sterilization. AIDS, more unsafe abortions, and unwanted pregnancies make this brave and angry plan even more relevant to addressing today's needs.
INTEGRATION. 1991 Sep; (29):4-5.The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.
Assessing the impact of new contraceptive technologies on user satisfaction, use-dynamics, and service systems.
PROGRESS. 1989; (11):2-3.A summary of the recommendations stemming from conference on the Demographic and Programmatic Consequences of Contraceptive Innovations, sponsored by the U.S. National Academy of Sciences in 1988, is provided by the WHO. While typical research on introduction of new contraceptive methods concerns cohort studies of users' problems and perspectives, a larger view of use-dynamics, choice behavior and client satisfaction with overall care is lacking. It is popular to hypothesize that user satisfaction improves with numbers of contraceptive options, but the literature does not provide clear evidence on this point, and none at all on introduction of new methods. Three main issues should be addressed: what is the impact of a new method on client perception of overall care, on contraceptive behavior, and on operation of the family planning program. To get this information usually requires prohibitively costly, time-consuming research. Low cost approaches are available, however, taken from the type of large-scale, community-based repeat observation studies now used to monitor trials of pharmaceuticals for tropical diseases, and treatments of rare conditions, such as vitamin A. Statistical techniques have been developed to adjust for censoring bias. Another type of field research that can be adapted to this research is the epidemiological field research of the type used in the Matlab, Bangladesh cholera vaccine study, later utilized to study acceptance of family planning services. Without such studies, the social and programmatic rationale for introduction of new contraceptives will be open to debate.
Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2, Background documents.
Copenhagen, Denmark, Scriptor, 1983. 2 986 p.Volume 2 of papers from an international symposium starts with chapter 7--available methods of fertility regulation; problems encountered in family planning programs of developing countries. Natural family planning is discussed here, as well as contraceptives and male and female sterilization. Chapter 8 covers research problems with regard to epidemiological, service, and psychosocial aspects of fertility regulation. Family planning is stressed in this chapter. Chapter 9 discusses future methods of fertility regulation: progress in selected areas. New contraceptive agents are discussed, such as luteinizing hormone releasing hormone and its analogues, gossypol for men, and immunological methods of fertility regulation. Chapter 10 also discusses future methods of fertility regulation, but from the point of view of research needs and priorities as viewed by program directors and advisers. Views and research priorities of the Population Council, and the Indian Council of Medical Research are given. Research needs and priorities in China are discussed, as is the role of the World Health Organization's Special Program of Reseach, Development and Reserch Training in Human Reproduction. Lastly, chapter 11 covers the role of governments, agencies and industry in reseach on fertility regulation. The role of the Agency for International Development, the US National Institutes of Health; and the World Bank, among others, are discussed.
Geneva, Switzerland, WHO, 1983 Nov. 167 p.As the main instrument within WHO for promoting and coordinating international research and development relating to family planning, the Special Programme aims to improve the health status of the populations of developing countries by: devising improved approaches to the delivery of family planning care in the primary health care context; assessing the safety of existing methods of fertility regulation; developing new birth control technology; and generating the knowledge and technology required for the prevention and treatment of infertility. The 2nd and related objective of the Programme is to promote national self-reliance for research in family planning by collaborating with national authorities in building up manpower and facilities that will enable developing countries to plan and carry out research, adapt technology, and contribute fully to the advancement and application of science. The major topics under review are research and development, institution strengthening, dissemination of information, and relations with industry and patents. The chapter on research and development includes a discussion of: delivery of family planning care; current methods of fertility regulation; development of new methods such as new intrauterine devices, sterilization and birth control vaccines; infertility; and interagency coordination on biomedical research in fertility regulation.